Does the addition of inpatient aquatic physiotherapy hasten recovery after total joint replacement surgery?

INTERVENTION: All participants received standard post‐operative ward physiotherapy as clinically determined by the treating physiotherapist for the first three days post‐operatively. Throughout the intervention stage of the trial, from Day 4 to discharge, all participants continued to receive one ward physiotherapy treatment each day, following the standard orthopaedic clinical pathway used at the hospital. The experimental treatment was in addition to usual care. From Day 4 after surgery, participants completed one of the two aquatic treatment programs each day until discharge. All treatments were one‐on‐one individual physiotherapy treatment sessions to standardise intervention between the groups and also to allow close monitoring of the physiological response to immersion in the early days after surgery. The aquatic physiotherapy intervention consisted of exercises in 30% weight‐bearing (chest deep water) focusing on strength using speed of movement as well as functional activities such as step ups and squats, walking forwards, backwards and sideways, balance exercises and open‐chain strengthening exercises using equipment for increased resistance eg flippers. The water exercise program was undertaken in 10% weight‐bearing (neck‐deep water) at a slow speed and involved exercises such as marching and single‐leg standing on the non‐operated leg, walking forwards and general upper limb strengthening exercises. The number of additional physiotherapy treatments was recorded for all participants and on average, participants received 3.5 additional treatments while in hospital. Each treatment session lasted 40 minutes and the average length of stay was 7.5 days. The primary end‐point of the trial was Day 14. After discharge home from the acute hospital and having completed the Day 14 assessments, participants were free to undertake whatever, if any, post‐operative physiotherapy they chose. CONDITION: hip and knee arthroplasty PRIMARY OUTCOME: Functional recovery measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) LK 3.1 (V3 Australia) Hip abductor strength of operated limb, measured by hand‐held dynamometer Improvement in walking speed measured by the 10m walk test, timed with a stopwatch from a standing start SECONDARY OUTCOME: Recovery of quadriceps and hamstrings strength of operated limb, measured with hand‐held dynamometer Return to participation in usual activities measured using the Patient‐Specific Functional Measure Self‐efficacy measured using two sub‐scales of the Arthritis Self Efficacy Scale: self‐efficacy to achieve outcomes and self‐efficacy to manage symptoms recovery of functional mobility by using the time taken to complete the timed Up and Go test, timed with a stopwatch resolution of post‐operative swelling measured with a tape measure at mid‐patella level and recovery of active range of motion measured using a goniometer INCLUSION CRITERIA: all people from one orthopaedic surgery practice undergoing primary knee or hip replacement surgery for osteoarthritis in The Wesley Hospital who were able to be assessed at home before admission and lived within the Brisbane metropolitan area for follow‐up after surgery